Quality of care and safety measures of acute renal replacement therapy: Workgroup statements from the 22nd acute disease quality initiative (ADQI) consensus conference

Abstract

Purpose: There is wide variation in the practice of acute renal replacement therapy (RRT). Quality of care is suboptimal, and substantial knowledge-to-care gaps need to be addressed. The quality of care for patients receiving acute RRT has been recognized as a clinical and research priority. Quality indicators (QIs) can be implemented to measure the quality of care received by patients and further be used as targets for continuous quality improvement initiatives focused on the prescription, delivery, and monitoring of acute RRT care.

Methods: The 22nd ADQI meeting was held in San Diego, USA, from October 28th to 30th 2018. Prior to the meeting, a literature review was conducted, and 3 teleconferences were held to develop research questions and consensus statements. These were presented at the meeting and refined before being approved by all ADQI delegates.

Results: Four research questions and fifteen consensus statements were generated. These focused on monitoring the quality of acute RRT along with the Donabedian quality measure domains of structure, process, and outcome. Recommendations for clinical practice and a research agenda for each question were also proposed.

Conclusion: Currently, there remains few validated QIs for acute RRT. These need further evaluation, need benchmarks established, and ultimately require implementation into clinical practice.

Keywords: Acute kidney injury; Continuous renal replacement therapy; Dose; Intensity; Outcome; Quality.